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Burnett County Subdivision Permit Application Fees (must accompany form): <br />and/or Pre -Application Form or Ma Review Form Subdivision w/o survey: $50.00 <br />PP P Survey of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: 5200.00 + 550.00/lot <br />Alan Belisle <br />Owner: <br />Address: <br />Phone: <br />8495 County Road FF <br />Webster, WI 54893 <br />715-410-8382 <br />Buyer: <br />Address: <br />Phone: <br />Original Parcel Information <br />Parcel ID #: 016 3401 03200 section 1 Township 3 Range <br />Original Description (or attach copy): "'SM No. 3494, V.17, p.153 <br />Current Zoning: Floodplain Y/N: N Wetlands Y/N: Lake/River Class: <br />Name of Water Body: Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation Y/N: Managed Forestry Law Y/N: <br />New Parcel Information V. a�J <br />Proposed New Legal Description and Parcel Size: This lot wiii be divided to create a new <br />lot of about 1 acre around the existing cabin and garage. An easement will be <br />provided to access CTH FF Acres: 1.0 A + 10.99A <br />(if parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Direct Access to CTH F and private easement <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner: <br />atgnature of owner: <br />➢ Does parcel meet Zoning Requirements? <br />N ➢ Does parcel require a Survey? <br />o <br />13 <br />Permit application fees submitted? <br />❑ Reconciles with Real Property Lister <br />If not, explain: <br />a <br />e� <br />0 <br />CL Application <br />y Land Use: <br />D�sI <br />Date: <br />Late: <br />Yes No <br />Yes No <br />Amount $ 3 , �) Receipt # <br />Yes <br />wed / Denied Reason for Denial: <br />% <br />0D wluA <br />No Date: <br />/7 Date: <br />O <br />v <br />m <br />